Bill To:


Great American Insurance
P.O. Box 5425
Cincinnati, OH 45201-5425

Services Rendered To:


Brisehida Martens
7154 FM 1458
Sealy, Texas 77474
POLICY # E452852


Product
Price
Qty
Amount
  1. 106 Battalion/Chief Vehicle Response (Per Hour)

    $150.00
    3.75
    $562.50
  2. 105 Utility Vehicle Response (Per Hour)

    $150.00
    3.75
    $562.50
  3. 102 Engine Response (Per Hour)

    $350.00
    3.75
    $1,312.50
  4. 105 Utility Vehicle Response (Per Hour)

    $150.00
    3.75
    $562.50
  5. 309 Power Tool (# Used)

    $50.00
    2
    $100.00
  6. 402 Fire/Police Services (Per Hour)    

    $100.00
    3.75
    $375.00
  7. 205 Foam (Per Gallon)

    $65.00
    35
    $2,275.00
  8. 306 Gas/Co Detector (# Used)

    $50.00
    1
    $50.00
  9. 313 TIC Thermal Imaging Camera (# Used)

    $100.00
    1
    $100.00
  10. 318 Ladder (# Used)

    $35.00
    2
    $70.00
  11. 301 Hand Tool (# Used)

    $15.00
    8
    $120.00
  12. 303 SCBA Breathing Apparatus (# Used)

    $50.00
    5
    $250.00
  13. 304 SCBA Cylinder (# Used)

    $25.00
    5
    $125.00
  14. 207 Wetting Agent (Amt Used)

    $25.00
    35
    $875.00
  15. 306 Hose Per 50′ (Amt Used)

    $25.00
    8
    $200.00
  16. 503 ** Damaged / Destroyed Equipment **

    1 ) FLIR K2 Thermal Camera Kit with MSX

    2 ) FLIR Battery Pack

    3) 1″ Attack Hose

    * See attached estimate for replacement

    $2,171.00
    1
    $2,171.00

  17. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 7154 FM 1458 Sealy, Texas 77474

Subtotal $9,711.00
Total Due $9,711.00


Updated
April 25, 2022 @ 5:26 pm

Invoice updated by Geoffrey.

Status Update
April 25, 2022 @ 5:26 pm

Status changed: Draft to Pending.

Updated
April 25, 2022 @ 5:30 pm

Invoice updated by Geoffrey.

Viewed
October 22, 2022 @ 8:35 pm

Invoice viewed by 64.124.8.32 for the first time.